Measuring the impact of gastrointestinal inconvenience and symptoms on perceived health in the general population – validation of the Short Health Scale for gastrointestinal symptoms (SHS-GI)

Figures & data

Figure 1. The general Short Health Scale (SHS-GI). Rating refers to symptoms/inconvenience during the last week.

Figure 2. The gastrointestinal diary.

Table 1. Demographics, SHS scores and fit statistics in the different samples.

Sample	General population	Crohn’s disease	Ulcerative colitis	Fecal incontinence
	Study 1	Study 2	Study 3	Study 4
Scale	SHS-GI	SHS-IBD	SHS-IBD	SHS-GI
n	201	498	307	51
Age, median (IQR)	57 (49–64)^a	46 (33–56)	46 (36–58)	57 (40–67)
Age range	22–71	17–82	10–88	27–78
Women n (%)	79 (38.9%)	293 (59.0%)	134 (44.1%)	51 (100%)
SHS symptom, median (IQR)	6 (0–24)	21 (4–50)	6 (0–28)	55 (37–75)
SHS function, median (IQR)	0 (0–9)	23 (2–60)	3 (0–30)	49.5 (19–73.5)
SHS worry, median (IQR)	0 (0–18)	25 (6–56)	15 (2–45)	66 (29.5–83)
SHS general, wellbeing median (IQR)	6 (0–23)	23 (6.5–52)	14 (0–39)	20.5 (10–55)
SHS total score, median (IQR)	32 (0–82)	107 (32–207)	55 (12–131)	204 (119–261)
Measure of fit (reference ideal fit)
Chi^2/df (<5.0)	1.05	1.39	5.23	0.91
RMSEA (<0.05)	0.016	0.028	0.124	<0.001
Residual Chi-square test p value (p > .05)	0.35	0.25	0.005	0.40
The comparative fit index (>0.95)	1.00	0.999	0.986	1.00
Tucker–Lewis index (>0.95)	0.999	0.998	0.957	1.01
Cronbach’s alpha for scale	0.80	0.89	0.88	0.72

SHS: short health scale GI version or IBD version; RMSEA: root mean square error of approximation; IQR: interquartile range, quartiles 1–3.

^aAt original investigation.

Table 2. Intercorrelations between SHS-items in the four samples.

SHS item	Symptom	Function	Worry	General wellbeing
General population
Symptom	1.00	–	–	–
Function	0.64	1.00	–	–
Worry	0.70	0.58	1.00	–
General wellbeing	0.37	0.30	0.40	1.00
Crohn’s disease
Symptom	1.00	–	–	–
Function	0.78	1.00	–	–
Worry	0.65	0.68	1.00	–
General wellbeing	0.65	0.70	0.61	1.00
Ulcerative colitis
Symptom	1.00	–	–	–
Function	0.78	1.00	–	–
Worry	0.65	0.70	1.00	–
General wellbeing	0.53	0.58	0.58	1.00
Fecal incontinence
Symptom	1.00	–	–	–
Function	0.79	1.00	–	–
Worry	0.59	0.61	1.00	–
General wellbeing	0.05	0.18	0.15	1.00

Table 3. Criteria variables in the general population sample.

Variable	Median (IQR)	Min	Max
Questionnaire
IBS n (%)	24 (11.9%)
Epigastric pain n (%)	25 (12.3%)
Anxiety (HAD)	4 (2–7)	0	18
Depression (HAD)	2 (1–4)	0	10
Diary
Total pain episodes	0 (0–4)	0	266
Nr days with pain	0 (0–1)	0	14
Nr days with urgency	1 (0–4)	0	14
Nr days with straining	4 (1–7)	0	14
Nr days with complete evacuation	11 (7–13)	0	14
Nr days with incomplete evacuation	1 (0–3)	0	14
Nr days with 1+ BM	13 (12–14)	2	14
Nr days with normal stool	9 (7–12)	0	14
Nr days with hard stool	2 (0–5)	0	14
Nr days with loose stool	.5 (0–2)	0	12
Max severity (in those with pain, n = 65)	2 (1–2)	1	3
Endoscopy
Diverticulosis (missing data = 5) n (%)	42 (21.2%)	–	–
Polyposis (missing data = 5) n (%)	11 (5.6%)	–	–
Spirochetosis (missing data = 5) n (%)	2 (1.0%)	–	–

HAD: hospital anxiety and depression scale; BM: bowel movement; IQR: interquartile range, quartiles 1–3.

Table 4. Spearman correlation (Spearman’s Rho with p value) between SHS total score and items with criteria variables in the general population sample.

Variable	Total score	Symptom	Function	Worry	General wellbeing
Age (at the time of the original investigation)	−0.11	−0.1300	−0.0559	−0.0606	−0.1183
Gender	−0.21**	−0.27***	−0.15*	−0.18**	−0.15*
HAD anxiety	0.42***	0.29***	0.28***	0.35***	0.50***
HAD depression	0.31***	0.16*	0.17*	0.24**	0.47***
IBS	0.35***	0.38***	0.33***	0.33***	0.16*
Epigastric pain	0.35***	0.40***	0.33***	0.30***	0.17*
Total pain episodes	0.49***	0.49***	0.42***	0.54***	0.31***
Nr days with pain	0.49***	0.48***	0.41***	0.54***	0.30***
Nr days with urgency	0.41***	0.40***	0.37***	0.47***	0.26***
Nr days with straining	0.23**	0.20**	0.18	0.24**	0.13
Nr days with complete evacuation	−0.26***	−0.31***	−0.18*	−0.27***	−0.21***
Nr days with incomplete evacuation	0.34***	0.38***	0.24**	0.35***	0.26***
Nr days with 1 + BM	−0.09	−0.08	0.03	−0.05	−0.13
Nr days with normal stool	−0.15*	−0.17*	−0.09	−0.21**	−0.10
Nr days with hard stool	0.14	0.15	0.07	0.10	0.15
Nr days with loose stool	0.24**	0.20**	0.26***	0.28***	0.13
Max severity (in those with pain, n = 62)	0.25	0.21	0.05	0.11	0.41***
Diverticulosis (missing data = 5)	0.03	0.01	0.07	0.03	−0.02

HAD: hospital anxiety and depression scale; IBS: irritable bowel syndrome: BM: bowel movement.

***p < .001; **p < .01; *p < .05.